The clinical data of one patient with advanced rectal cancer with rectovaginal fistula treated with bevacizumab combined with FOLFIRI were collected，and the characteristics and process of diagnosis and treatment were analyzed； the relevant literatures were summarized at the same time.

A 64-year-old female patient received transabdominal rectal cancer surgery （Dixon surgery） in People’s Hospital of Jilin Province，and the postoperative pathological results showed moderately differentiated rectal adenocarcinoma，invasion of posterior wall of vagina and regional lymph node metastasis （pT4bN2M0， Stage ⅢC，Dukes C）；the immunohistochemistry results showed MHS2（+），MLH1（+），PMS2（+），MSH6（+），S-100（－），and BRAFV600E（－），indicating proficiency of mismatch repair（pMMR）；the patient had N- and K-RAS gene mutations.The pelvic MRI results at 4 weeks after surgery revealed the postoperative rectovaginal fistula before pre-adjuvant chemotherapy.The chemotherapy was postponed， and the disease continued to progress 5 months after surgery， and the palliative first-line and second-line chemotherapy were perfermed under compulsion.However， the disease continued to progress， and the third-line chemotherapy of bevalizumab combined with FOLFIRI regimen was performed and did not aggravate the rectovaginal fistula， and promoted the fistula healing，while significantly improved the quality of life of the patient.

Bevacizumab combined with chemotherapy is a feasible treatment option for the rectal cancer patients with rectovaginal fistula caused by the tumor progression and will not benefit from the cetuximab therapy.